Understanding equitable and affirming communication moments and relationship milestones during the intensive care unit journey: findings from stage 1 of a design thinking project.

PURPOSE: Communication is vital to facilitate patient and family-centred care (PFCC) and to build trusting relationships between intensive care unit (ICU) health care providers, the patient, and their loved ones in the ICU. The focus of this investigation was to identify, define, and refine key moments of communication, connection, and relationship building in the ICU through a lens of Equity, Diversity, Decolonization, and Inclusion (EDDI) to encourage meaningful communication and development of trusting relationships. METHODS: We conducted 13 journey mapping interviews with ICU health care providers, patients, and their loved ones as the first stage in a design thinking project. We used directed content analysis to identify intersections where principles of EDDI directly or indirectly impacted communication, relationships, and trust throughout the ICU journey. To serve diverse patients and their loved ones, accessibility, inclusivity, and cultural safety were foundational pillars of the design thinking project. RESULTS: Thirteen ICU health care providers, patients, and their loved ones participated in journey mapping interviews. We defined and refined 16 communication moments and relationship milestones in the journey of a patient through the ICU (e.g., admission, crises, stabilization, discharge), and intersections where EDDI directly or indirectly impacted communication and connection during the ICU journey. CONCLUSION: Our findings highlight that diverse intersectional identities impact communication moments and relationship milestones during an ICU journey. To fully embrace a paradigm of PFCC, consideration should be given to creating an affirming and safe space for patients and their loved ones in the ICU.

RéSUMé: OBJECTIF : La communication est essentielle pour faciliter les soins axés sur la patientèle et la famille et pour établir des relations de confiance entre les prestataires de soins de santé de l'unité de soins intensifs (USI), la patientèle, et ses proches à l'USI. L'objectif de cette enquête était d'identifier, de définir et de peaufiner les moments clés de communication, de connexion et de création de relation aux soins intensifs sous l'angle de l'équité, de la diversité, de l'inclusion et de la décolonisation (EDID) afin d'encourager une communication profonde et la création de relations de confiance. MéTHODE: Nous avons mené 13 entretiens de cartographie du parcours avec des prestataires de soins et des patient·es de l'USI ainsi qu'avec leurs proches dans le cadre de la première étape d'un projet de réflexion conceptuelle. Nous avons utilisé l'analyse de contenu dirigée pour identifier les intersections où les principes de l'EDID ont eu un impact direct ou indirect sur la communication, les relations et la confiance tout au long du parcours aux soins intensifs. L'accessibilité, l'inclusivité et la sécurité culturelle ont constitué des piliers fondamentaux du projet de réflexion conceptuelle pour desservir une patientèle diverse et ses proches. RéSULTATS: Treize prestataires de soins et patient·es de l'USI et leurs proches ont participé à des entrevues de cartographie du parcours. Nous avons défini et affiné 16 moments de communication et jalons de la relation dans le parcours d'un·e patient·e à l'USI (p. ex. admission, crises, stabilisation, congé) et les intersections où l'EDID a eu une incidence directe ou indirecte sur la communication et la connexion pendant le parcours aux soins intensifs. CONCLUSION: Nos résultats soulignent que les diverses identités intersectionnelles ont un impact sur les moments de communication et les jalons de la relation lors d'une trajectoire aux soins intensifs. Pour adopter pleinement un paradigme de soins axés sur la patientèle et sa famille, il faudrait envisager de créer un espace d'affirmation et de sécurité pour les patient·es et leurs proches à l'unité de soins intensifs.

Testing the role of body size and litter depth on invertebrate diversity across six forests in North America.

Ecologists search for rules by which traits dictate the abundance and distribution of species. Here we search for rules that apply across three common taxa of litter invertebrates in six North American forests from Panama to Oregon. We use image analysis to quantify the abundance and body size distributions of mites, springtails, and spiders in 21 1-m2 plots per forest. We contrast three hypotheses: two of which focus on trait-abundance relationships and a third linking abundance to species richness. Despite three orders of magnitude variation in size, the predicted negative relationship between mean body size and abundance per area occurred in only 18% of cases, never for large bodied taxa like spiders. We likewise found only 18% of tests supported our prediction that increasing litter depth allows for high abundance; two-thirds of which occurred at a single deciduous forest in Massachusetts. In contrast, invertebrate abundance constrained species richness 76% of the time. Our results suggest that body size and habitat volume in brown food webs are rarely good predictors of variation in abundance, but that variation in diversity is generally well predicted by abundance.

The effect of music on anaerobic exercise performance and muscular endurance.

BACKGROUND: Music has been shown to improve aerobic and anaerobic exercise performance; however, music's effect on resistance training exercise, gender differences, and heart rate (HR) is less understood. The purpose of this study was to examine the effects of self-selected music on anaerobic exercise performance using a bench press (BP) protocol and the Wingate anaerobic test (WAT). METHODS: Fifteen (8 men; 7 women) healthy, college-aged students between 18-25 years old (20.1±1.79 yrs) participated in this study. Testing consisted of two trials (music [M]; no music [NM]] completed in a randomized order. Each participant performed the BP for a maximum number of repetitions using 70% one-repetition maximum for five sets. After a 10 min rest period, a 30 s Wingate anaerobic Test (WAT) was completed. RESULTS: During the M condition, there was a significant increase in total work (M: 16121.8±4287.3 kJ; NM: 15021.7±4370.6 kJ; P=0.024), relative peak power (M: 44.6±8.4 W; NM: 41.4±8.4 W; P=0.014), and the total number of bench press repetitions (M: 41.7±8.7 reps; NM: 38.3±8.1 reps; P=0.001). HR recovery following the WAT protocol was significantly quicker after the WAT protocol during the M condition (M: 256.2±54.5 sec.; NM 293.3±22.3 sec.; P=0.022). There was no significant condition as for gender interaction for any of the variables assessed. CONCLUSIONS: Listening to self-selected music improved exercise performance during the BP and the WAT. Music also hastened HR recovery following the WAT.

Sodium co-limits and catalyzes macronutrients in a prairie food web.

Nitrogen and phosphorus frequently limit terrestrial plant production, but have a mixed record in regulating the abundance of terrestrial invertebrates. We contrasted four ways that Na could interact with an NP fertilizer to shape the plants and invertebrates of an inland prairie. We applied NP and Na to m2 plots in a factorial design. Aboveground invertebrate abundance was independently co-limited by NaCl and NP, but with +NP plots supporting more individuals. We suggest the disparity arises because NP enhanced plant height by 35% (1 SD) over controls, providing both food and habitat, whereas NaCl provides only food. Belowground invertebrates showed evidence of serial co-limitation, where NaCl additions alone were ineffectual, but catalyzed access to NP. This suggests the increased belowground food availability in NP plots increased Na demand. Na and NP supply rates vary with climate, land use, and with inputs like urine. The co-limitation and catalysis of N and P by Na thus has the potential for predicting patterns of abundance and diversity across spatial scales.

Childhood Obesity in an Inner-City Primary Care Population: A Longitudinal Study.

BACKGROUND: Understanding the dynamics of obesity among children and adolescents in high-risk, low-income patient populations is critical to guide and evaluate appropriate clinical and public health interventions. METHODS: We identified a cohort of 472 predominantly low-income, minority pediatric patients aged 3-18 years with baseline measurements in 2010 and analyzed follow-up data through September 2013. Weight status at baseline and end of follow-up were ascertained. RESULTS: The prevalence of obesity was 25% (95% confidence interval [CI] 21%-29%) at baseline and 24% (95% CI 20%-28%) after an average of 2.3 years follow-up. Among the 353 subjects who were not obese at baseline, the cumulative incidence of obesity was 8% (95% CI 5%-11%). Those who were normal weight at baseline had an incidence of 3% (1%-6%); those who were overweight had an incidence of 22% (95% CI 14%-32%). Among the 119 subjects who were obese at baseline, 29% (95% CI 21%-38%) were not obese at the end of follow-up. Remission of obesity among those who were severely obese was only 12% (95% CI 4%-26%); among other obese patients remission was 38% (95% CI 28%-50%). CONCLUSION: The prevalence of obesity did not change substantially during follow-up. The cumulative incidence of obesity was 8%, and most of the incidence was among children who were overweight at baseline. Remission was common, especially among those who were not severely obese at baseline. Understanding and addressing determinants of obesity over the lifecourse is critical to the long-term health of children in the United States.

Recognition and Management of Elevated Blood Pressure in Pediatric Patients: Challenges and Disparities in Community Health Centers.

The prevalence of childhood elevated blood pressure (EBP)-a single blood pressure recording above the normal range-is increasing in the United States. Recognizing childhood EBP is difficult because classification is a function of age, sex, and height. We assessed the frequency of clinical recognition of EBP and follow-up care in a sample of pediatric patients seen in 2010 and followed up through September 2013 in a network of 8 urban health centers. Of 754 patients with BP measurements, 261 (35 %) had at least 1 EBP reading during the study period. Of those with an EBP reading, 52 (20 %) had at least 1 EBP reading noted in their medical record. Clinicians were more likely to recognize EBP in overweight/obese [OR 3.27 (95 % confidence interval (CI) 1.64-6.51)] and male [OR 2.83 (95 % CI 1.64-4.42)] children. Strategies to support routine monitoring of BP status could improve identification and management of pediatric EBP.

Changes in multi-segment foot biomechanics with a heat-mouldable semi-custom foot orthotic device.

BACKGROUND: Semi-custom foot orthoses (SCO) are thought to be a cost-effective alternative to custom-made devices. However, previous biomechanical research involving either custom or SCO has only focused on rearfoot biomechanics. The purpose of this study was therefore to determine changes in multi-segment foot biomechanics during shod walking with and without an SCO. We chose to investigate an SCO device that incorporates a heat-moulding process, to further understand if the moulding process would significantly alter rearfoot, midfoot, or shank kinematics as compared to a no-orthotic condition. We hypothesized the SCO, whether moulded or non-moulded, would reduce peak rearfoot eversion, tibial internal rotation, arch deformation, and plantar fascia strain as compared to the no-orthoses condition. METHODS: Twenty participants had retroreflective markers placed on the right limb to represent forefoot, midfoot, rearfoot and shank segments. 3D kinematics were recorded using an 8-camera motion capture system while participants walked on a treadmill. RESULTS: Plantar fascia strain was reduced by 34% when participants walked in either the moulded or non-moulded SCO condition compared to no-orthoses. However, there were no significant differences in peak rearfoot eversion, tibial internal rotation, or medial longitudinal arch angles between any conditions. CONCLUSIONS: A semi-custom moulded orthotic does not control rearfoot, shank, or arch deformation but does, however, reduce plantar fascia strain compared to walking without an orthoses. Heat-moulding the orthotic device does not have a measurable effect on any biomechanical variables compared to the non-moulded condition. These data may, in part, help explain the clinical efficacy of orthotic devices.